#400 Malnourished Mind: Nutrient Deficiencies In Mental Health & Anorexia with James Greenblatt, MD

 🎉 IT’S OUR 400TH EPISODE, BABY!! 🎉
Cue the confetti and the magnesium… because this week on The Less Stressed Life, we’re talking about one of my favorite topics: how nutrient deficiencies can straight-up wreck your mental health—and how to fix it.

Joining me is Dr. James Greenblatt, a total legend in the world of integrative psychiatry (he’s been using nutrition to treat mental illness since before I was drinking coffee ☕️). And y’all, he is dropping truth bombs left and right.

If your lab work says “normal” but you feel like a hot mess... this one’s for you. 🧠✨ 

Get free access to the webinar Answers to Anorexia: Malnourished Minds through May 31, 2025 with code LESSSTRESSED → https://www.courses.psychiatryredefined.org/courses/anorexia-nervosa-malnourished-minds-webinar

Psychiatry Redefined offers clinician training programs starting this spring/summer—including an intensive for therapists and a new Pediatric Functional Psychiatry Fellowship. Learn more: https://www.psychiatryredefined.org/

💡 KEY TAKEAWAYS:

💥 Why your brain is the ultimate nutrient hog
💥 How low B12, D, magnesium, and zinc can mimic anxiety, depression & ADHD
💥 Why zinc deficiency looks a LOT like anorexia (👀 shocking but true)
💥 The most misunderstood brain nutrient ever: lithium (nope, not the prescription kind)
💥 How to use testing smartly to find what your brain's really missing 

ABOUT GUEST:
Dr. James Greenblatt is a board-certified child and adult psychiatrist and a pioneer in integrative and nutritional psychiatry. Since 1988, he’s been using personalized, evidence-based approaches to treat mental health conditions by addressing underlying nutrient and biochemical imbalances. He trained at George Washington University and completed a fellowship at Johns Hopkins, has served as a clinical professor at Tufts and Dartmouth, and is the author of eight books—including Finally Focused and Answers to Anorexia. He’s also the founder of Psychiatry Redefined, an educational platform for integrative mental health professionals. 

WHERE TO FIND:
Website: https://www.jamesgreenblattmd.com/
Instagram: https://www.instagram.com/psychiatry_redefined

WHERE TO FIND CHRISTA:
Website: https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife

SPONSOR:
Thanks to Jigsaw Health for sponsoring this episode! Struggling with dry, cracked hands? Try their Alaska Cod Liver Oil for omega-3s + vitamins A & D to support skin and immune health. Use code LESSSTRESSED10 at JigsawHealth.com for 10% off—unlimited use!

WORK WITH CHRISTA:
I've streamlined my proven method to help you get to the REAL root of eczema and food sensitivities—without the overwhelm. Join the program at christabiegler.com before doors close!

Transcript

[00:00:00] James Greenblatt, MD: the brain. Is only a few pounds or maybe, 3% of our body weight, but it's utilizing, a quarter of our metabolic energy. So it's burning micronutrients faster than any other organ. So every single nutrient is critical for brain function and it's really important. 

[00:00:21] Christa Biegler, RD:  I'm your host, Christa Biegler, and I'm going to guess we have at least one thing in common that we're both in pursuit of a less stress life. On the show, I'll be interviewing experts and sharing clinical pearls from my years of practice to support high performing health savvy women in pursuit of abundance and a less stressed life.

[00:00:51] One of my beliefs is that we always have options for getting the results we want. So let's see what's out there together.

[00:01:08] Alright, today on the Less Stressed Life, I have Dr. James Greenblatt with me, who is a board certified child and adult psychiatrist and a pioneer in the field of integrative medicine since 1988. He's helped patients through a personalized nutrition-based approach to mental health. He completed his training at George Washington University and Fellowship in child psychiatry at John Hopkins and currently serves as a 

[00:01:31] assistant clinical professor at both Tufts and Dartmouth Medical Schools. Dr. Greenblatt is the author of eight books, including the bestselling. Finally Focus, the Breakthrough Natural Treatment Plan for A DHD, which when I read this in his bio, I was excited because I. Didn't know that this book existed.

[00:01:46] I just had his anorexia book. And then I think he's got two, but I'll let him correct me, but Answers to Anorexia, which was updated in 2021 and his newest book, functional and Integrative Medicine for Antidepressant Withdrawal. He's also a founder of Psychiatry redefined and educational platform advancing evidence-based integrative psychiatry.

[00:02:04] Welcome to the show, Dr. Greenblatt. 

[00:02:06] James Greenblatt, MD: Thank you Chris. It's good to be with you. 

[00:02:08] Christa Biegler, RD: Yeah, so I already told him offline. Why did I invite you to the show? So we had Erin Falco, who was a dietician here a while back. I don't remember exactly when. Our topic was so fascinating and she spoke at a dietician conference I was at, and I think why I loved the presentation is I love case studies.

[00:02:28] I. Love a good case study. Tell me the results that you see. Please don't just tell me what your research is, but how it applies clinically. So I know that she learned and gained so much from you, and I'm actually not sure how your relationship started, but what I think is interesting to me off the out the gate with you is that you were.

[00:02:50] This all started since 1988 you've been looking at nutrition as a part of psychiatry, which if you started to do that now, I feel that it would be progressive. So in 1988 you were like on a different planet perhaps. So I'd love to hear how this somewhat start.

[00:03:06] How did you get into this topic? How did you bring nutrition into psychiatry? 

[00:03:12] James Greenblatt, MD: Some might say it started in 1980. I. So in, in college I just had this interest in nutrition and brain function. I did papers on what was called orthomolecular psychiatry, which is high dose vitamin B three for schizophrenia.

[00:03:28] And I was interested in the integrative medicine world. I went to medical school thinking I was gonna cure the planet with kale and brown rice. And that was before people were eating kale. And then, going through medical school and as a child psychiatrist, I came out prescribing meds for children, as a psychopharmacology.

[00:03:49] And it only took a few years in practice to realize why I went into medicine is to understand the role of diet and lifestyle. And since the nineties have been able to not only, learn the material, but teaching has been a big part of my career, since 1990. 

[00:04:08] Christa Biegler, RD: Yeah. Okay.

[00:04:09] So you are interested in nutrition. It makes sense, right? What we value, we tend to step forward with. I am guessing you had a little pushback. We don't have to cover all of this uphill battle that you may or may not have had, since the eighties. But I'm curious, where did you started in college, you were digging into things at that point, was there a lot of literature for you to draw from, to allow you to implement nutrition therapy into practice immediately at that time?

[00:04:36] James Greenblatt, MD: Really good question because I remember in 1993 giving my first talk to the community, there was like 200 people in the audience on A DHD. And at that time I remember having to say that we have no research to support ultra processed foods and sugar affects behavior. But, and then I went to case studies and what parents share and what we knew, but I remember that line.

[00:05:03] I have no research. 'cause at the time, pediatricians said refined sugar and ultra processed foods are fine. And now we have scores of research looking at ultra processed foods affecting depression, anxiety, even. Cognitive decline. So the research was minimal, but there's been a community now going back 60, 70 years that have been looking at integrative and functional medicine for mental health.

[00:05:30] So I've been able to practice some and I think bridge both worlds of traditional psychiatry. With the integrative and functional world and patients just got better and it just reinforced the work that I was doing at that time. Now the research has exploded. 

[00:05:48] Christa Biegler, RD: I wanna start actually with a story or two, whatever kind of sticks out to you.

[00:05:53] And I know that there is probably hundreds if not thousands of stories, but maybe if we, since we're back in the eighties right now in this conversation, you said you, you gave that first talk on a DHD, but what did it look like when you started giving nutrition? Do you remember some of the things that happened as you started implementing nutrition?

[00:06:12] Then I wanna get a little bit more granular as well, but. I just, I love stories, right? So tell us what it looked like. 

[00:06:20] James Greenblatt, MD: Yeah, lots of stories. Hundreds if not thousands. And they all started with if we take a DHD might be the simplest, and then, we'll, I. Move on. But with every disorder, parents coming in, one parent saying, medicate my kid, and the next parent, and saying, I don't want medicines.

[00:06:38] And the approach is always the same. Medicines aren't evil, but let's look at nutritional deficiencies first. And by doing some simple tests, we're able to help determine if there is a nutritional deficiency affecting the behaviors or if there's a hormonal problem or a gut problem. So we're always looking early in, in the careers, looking at objective data.

[00:07:03] So I'm not just throwing supplements at patients, I'm saying. Your child has a deficiency of magnesium or you are coming in with a history of depression and we check and you have very low vitamin B12. So the stories were just adding simple micronutrients based on the testing. So B12 completely reversing depression.

[00:07:29] Vitamin D levels are so important for brain function, but aren't routinely checked, certainly not 20 years ago by psychiatrists. So we, I can have scores of depressed, I had bipolar adolescents with very low vitamin D levels. The most common nutritional deficiency we see is magnesium across mental health practices.

[00:07:53] So we have kids sleeping better. I. So it, it's just a model based on objective laboratory testing, working towards a individualized path of utilizing micronutrients to treat mental illness. 

[00:08:10] Christa Biegler, RD: So something interesting that you say is that you were doing testing and I would say that. We have opportunities for testing around every nutrient you just mentioned B12, for sure.

[00:08:22] That's an easy one. Vitamin D, also easy magnesium, zinc. It's not going to be common. In fact, I remember when my mother was in the ICU in 2021 and I asked for a vitamin D and they could not find it. In the testing which was quite disappointing for me actually. But I would say that I feel that nutrient testing is not as straightforward as showing up to the provider and saying, will you test my nutrients?

[00:08:49] Because it's not commonplace even to have a B12 checked or a vitamin D checked is, even though those are. I think quite easy to get. They're not super common. And so I'm curious I have two questions. Did you have more access to more testing? I don't know if you were affiliated with the university at that time.

[00:09:09] I. Which may or may not have allowed you to have more access, or did you feel that it actually was quite accessible? So that's the first question. And then I wanna ask if with magnesium you were checking red blood cell, magnesium or something else, and with zinc, if it was plasma, zinc or some other way.

[00:09:27] James Greenblatt, MD: Let's start with your comment. Vitamin B12 and D. These are simple tests. They are. Occasionally done the implications for completely transforming our mental health treatment model is just staggering and profound and nobody's looking at it. And they should be done in every patient with a mental health illness.

[00:09:55] For me, I was fortunate, I was the chief medical officer at a facility at a hospital for 25 years where I was able to say, we're drawing these bloods on everybody that walks through the door. And then in, 

[00:10:09] Christa Biegler, RD: that's always helpful. 

[00:10:10] James Greenblatt, MD: Yeah. Yeah. It makes it a little easier. And we could see the tremendous, in my outpatient practice, I wouldn't see somebody.

[00:10:17] I don't think it was ethically for me to see a psychiatric patient and not understand those two markers because I could completely reverse major mental illness. Now, not with everybody, some people have normal B12 levels. But if we get a B12 level of 120 and 200, or even 300, and somebody says that's normal because the lap slip said normal.

[00:10:44] I've completely reversed someone's depression by giving them B12 shots. So these tests are available. They're covered by Medicaid, Medicare and most insurances, and it just really is important that both the consumer and clinicians just make sure it happens. 

[00:11:03] Christa Biegler, RD: I have to make a comment there. I know we have several questions tucked in here.

[00:11:06] Welcome, welcome to how I sometimes answer questions. Don't worry. I can re-ask them. You just mentioned something I wanna highlight and underline because every time we get into a conversation it's here's the pieces, right? It's like when people come to me and they say, I just had blood work. I'm like, I bet you had $3 worth of blood work.

[00:11:24] Alright, so go and ask for these tests. I've been in private practice for 10 years and then I did dialysis for about eight years before that. And in the time that I've been, I used to do a lot of nutrient testing. Actually this conversation takes me back to the nutrient testing that I had at that time.

[00:11:42] It was very fun to do because we got to see lots of results. But the point is when you go to the doctor and when you ask for B12, I'm disappointed by how the reference ranges are declining and. The current lab, I'm using the reference range, the low end I think is 2 52 to 1200.

[00:11:58] And you just said 100, 200 or 300. That would show as normal, right? If someone was at 300. For me, if it's under 500, I think it's too low. I don't think that there's a, with B vitamins, I don't think there's a negative to trialing the supplementation 'cause it's water soluble. So I'm curious for you, what's For me it's 500 is too low.

[00:12:16] What's too low for you? 

[00:12:18] James Greenblatt, MD: I've used that term 500 for 30 years and I can't tell you how many what I would call tragedies where people got their B12 levels, had the three tens were told it's not B12, and we saw them three years later and B12 reversed these conditions. And I've waited 30 years and a new research paper did come out in the last three or four months looking at these numbers between three and 500, and demonstrating that there were cognitive decline and other symptoms in that range.

[00:12:54] So a new study that just came out that put a little emphasis on what you were describing. 

[00:13:00] Christa Biegler, RD: I will also mention anytime someone has a low B12, I always like to talk about how that's upstream. It's a digestion problem. It's an animal protein problem. We'll get to that as well. B12 is found in animal products, so you have to digest it and then you must absorb it.

[00:13:15] And I would be curious what you think about this. I know you have spent, I believe you spent most of your career with children, but they say that. The aging population is known to have low B12, and I can't help but wonder if it's just the same things aforementioned where it's digestion and absorption.

[00:13:32] Or is it because there's something happening in aging where they have less intrinsic factor, I don't know where they're not absorbing it. So that's a comment for you to comment on if you want to. And I will also mention, you just mentioned mental health around B12. I wanna just offer that B12 is a nutrient for fatigue.

[00:13:49] A hundred percent in a very common it's not always, but it's a very common side effect when your B12 is low, is maybe extremity tingling. And I just remember a story of a young woman one time who had really low B12 in my practice, and had, this is what happens to humans. Her grandfather had a heart attack, and so she was having tingling extremities and her brain was going to, I'm gonna have a heart attack.

[00:14:09] And it was just low B12. And so I'm sure you have all kinds of stuff like that, but I really appreciate you saying that. I think this is like a very common tragedy, most likely also with B12 and so yeah. Any comment about the aging population having more B12? 

[00:14:24] James Greenblatt, MD: Yeah, 

[00:14:24] no, it's critical. I bring it up in the most every lecture because what happens is when we age and aging for the digestive system can start at age 30, we less hydrochloric acid.

[00:14:36] And so it's really, pretty significant. So acid in the stomach starts the whole digestive process for protein and helps start the digestive process for vitamin B12. So decreased stomach acid we see with people taking antacids, which most of the planet taken we see with aging. And we also see with chronic stress and PTSD, so low stomach acid and also zinc deficiency.

[00:15:05] So there's lots of paths where we can determine some of the underlying causes for vitamin B12 deficiencies. Sometimes, as you mentioned, it's dietary vegan or vegetarian might not get adequate vitamin B12. Other times it's more functional. There's just low stomach acid. 

[00:15:26] Christa Biegler, RD: Yeah, I would say I have a very health conscious population and.

[00:15:32] I'm not sure if anyone has great stomach acid because of stress and per probably nutrient co-factors. I just share that because I make jokes that they can put on my headstone that no one was digesting. Very well. So I have strong feelings about that. Okay, so we're talking about B12, we're talking about that as a really key point, and I feel like this is just a good time.

[00:15:55] I'm gonna go back to all those, I will a hundred percent go back to talking about testing of magnesium and zinc, but since we brought up dietary factors around vegetarian or vegan diets or not having animal foods. Something I've observed with interviews and with people for a long time is that when we're not digesting animal proteins, we're not getting not only B12, but also amino acids, which make up neurotransmitters.

[00:16:19] And it sounds like you may have some similar beliefs around what's the research related to health implications. Vegetarian and vegan diets. 

[00:16:29] James Greenblatt, MD: Yeah. The big picture is, and sometimes hard to say in an audience is, we have higher rates of anxiety and depression in, vegetarians and vegans and we have lower rates of some important micronutrients like zinc and B12.

[00:16:46] I think what's been critical to me practicing for so many years it's really not. The diet because we can have three vegetarians and one would have absolutely perfect amino acids. One would be low and one would be undetectable, very low. So it's really and that's why the objective testing is so important, but low levels of amino acids, fasting amino acids.

[00:17:12] It's been, as a psychiatrist, one of the most important tests that I've done particularly for symptoms of depression, fatigue, and anxiety. 

[00:17:22] Christa Biegler, RD: How are you testing amino acids? Fasting amino acids is this, 

[00:17:27] and 

[00:17:27] James Greenblatt, MD: these would be plasma blood tests. There are urine tests not as helpful, but some people do them.

[00:17:33] But these are fasting plasma amino acid tests, and I remember exactly when I started doing these tests. Because I checked the box by mistake in the nineties and I got this test back and it didn't make sense to me. What if someone had steak for dinner last night? What if someone had a salad? Then wouldn't that affect their plasma amino acids?

[00:17:52] But it really doesn't. It's a steady state and regardless of dietary intake some patients have low levels and high levels, and it usually is a result of adequate digestive enzymes and hydrochloric acid. 

[00:18:06] Christa Biegler, RD: Yeah, back to that same story. We all need to digest better. Always. Yeah. 

[00:18:10] James Greenblatt, MD: Yeah. 

[00:18:10] Christa Biegler, RD: Okay. So we started with the B12.

[00:18:13] I don't know if we need to cover vitamin D testing because it's pretty simple, pretty straightforward. But let's talk about, how about magnesium and zinc testing, because I don't feel that's, probably gonna get done without very specific request or self-ordering for most humans, if they don't have access to someone who has ordered that before.

[00:18:35] So with magnesium, there's different ways to do different things. So that's, I was wondering if you did red blood cell magnesium, a different type of magnesium, and then plasma, zinc, or in some other way. 

[00:18:46] James Greenblatt, MD: Magnesium and zinc are unique and the punchline is there's not one test that's gonna help you in as a clinician.

[00:18:55] So I look at RBC magnesium, a serum magnesium is useless unless you're, on dialysis or in the ICU. So most people so I do an RBC magnesium and often look at trace mineral magnesium in a hair test. But 99% of our magnesium is in our bones and our tissues and our cells. So we don't have a good way of assessing magnesium except for a good clinical history.

[00:19:26] So we have physical symptoms that reflect magnesium deficiency. I learned years ago this phrase, if it's spasms, think magnesium. And if you think of any disorder, whether it's asthma, lungs, migraines, interstitial cystitis, muscle twitches those are all magnesium deficiency kind of syndromes. If you think of anxiety, constipation.

[00:19:55] Insomnia are probably the three most common clinical symptoms of magnesium deficiency. So there's not one great test, but if you look at some of the tests and you look at the clinical symptoms I assure you clinically, if someone walks into the office that is not sleeping well, anxious, constipated, they are gonna feel a lot better with magnesium.

[00:20:23] Christa Biegler, RD: And how I totally agree with you and I find that I'm mostly doing mineral analysis for magnesium, and I think that there's an order to supporting minerals, and also most people feel. Better or symptomatic relief when they trial? Magnesium in general is what I've seen. To your point, my understanding is it's very slow to replete and so I'll share a little bit of a story.

[00:20:54] I remember once upon a time when I was doing lots and lots of, comprehensive micronutrient testing. And I had a really cool mentor from Texas. He was great. He tested lots of athletic teams and so I could always call him and ask for what the actual clinical dose of that nutrient that would make a difference was.

[00:21:11] And I remember talking to him about my twitching eyelid and how I knew it was magnesium deficiency and how annoying it was, but it would happen after I would drink too much coffee. And I share this because. It was increasing my cortisol and my stress and it was just part of what, how I was at that time more and I share that because stress is also depleting our magnesium. Maybe you have some other comments, but my question or comment I'd like you to comment on is that I understand that magnesium is really slow to replete and I tend to recommend topical absorption of magnesium quite a bit and I've had a lot of success with it.

[00:21:44] What do you see about. Like the reference I've been given is that it can take years to replete magnesium. And I think part of the conversation, and I think this is the conversation with hydrochloric acid and digestion as well, it is how much stress are you putting in? So how much are you depleting or dumping out, is how I think of it.

[00:22:04] But I'd love to hear what you think about repletion overall, because I think you need to support much longer than the symptoms subside. 

[00:22:13] James Greenblatt, MD: Yeah, no I use topical or magnesium sulfate bath as an adjunct, but I still do the pills usually magnesium glycinate, and it can take a while. Sometimes we see improvement in some of the symptoms more quickly.

[00:22:26] Two weeks, constipation, four weeks sleep. But oftentimes it can take. A while, and sometimes for magnesium repletion, you need B vitamins B six in particular. I do agree that it can take time. And I use a combination of topical and supplements, pills. 

[00:22:48] Christa Biegler, RD: Okay so far we've talked somewhat about DB 12, zinc, magnesium, and I wanna make sure we cover, I feel like we talked a little bit about amino acids.

[00:23:00] I feel like all nutrients could be brain nutrients, but I wanna talk about any other really common nutrient deficiencies you're seeing that are influencing brain health. What are we missing? You touched on just a little bit. B three at the very beginning and B six, and these are. I feel, again, not easy to test.

[00:23:16] I know that they were accessible for you, which I love, but so what other nutrients are we missing in brain Health and then any comments about testing around them? 

[00:23:25] James Greenblatt, MD: Yeah, I think we just need to assume every micronutrient is critical for brain health. Let's just put it in perspective.

[00:23:33] If the brain. Is only a few pounds or maybe, 3% of our body weight, but it's utilizing, a quarter of our metabolic energy. So it's burning micronutrients faster than any other organ. So every single nutrient is critical for brain function and it's really important. Some of the big ones that, that we see that we haven't talked about would be zinc.

[00:23:59] I've read, although I haven't seen the reference that every enzyme in the brain requires zinc. And zinc is critical to make the neurotransmitter serotonin also to make melatonin to help us sleep. So zinc is critically important, and zinc is primarily in animal food. So our vegetarians sometimes can be deficient and we see low zinc.

[00:24:24] Actually, I see a lot in addiction. I see a lot in my eating disorder patients. I see a lot in individuals that are doing the sweating yoga or the hot yoga and in asana. 'cause we lose zinc through sweating. So zinc deficiency is common. Probably the most common. Path that we see it in, in kids is elevations of copper, like copper water pipes.

[00:24:49] So copper is common and it just forces zinc down. So zinc is critically important for brain function and probably the most important micronutrient that I've used in my practice that I've been teaching about that I think is. By far the most helpful is actually lithium. The nutritional lithium. It is not prescription drug, lithium.

[00:25:13] It is the micronutrient that's critical for brain function. 

[00:25:17] Christa Biegler, RD: Let's talk about that one a little bit. I have about 12 questions from your little comment there, but let's talk about lithium first since you just dropped off there. Will you describe lithium to us? That was something I was always, I never really used in practice because one of my mentors said you never wanna mess up lithium.

[00:25:35] And I like that you just differentiated for a moment that there's medic prescription or medication Lithium. And the nutritional lithium. So can you just unpack lithium a little bit for us, why it's essential and how it supports brain health. 

[00:25:50] James Greenblatt, MD: Sure. And in our training program we have a two-day workshop, 16 hours on lithium from experts around the globe.

[00:25:59] So it is just a critical micronutrient for, particularly for brain health. But let's think of lithium as an element. It's in the periodic table. It is in the rock, in the earth crust. And we use this mineral. I think as everyone knows, lithium batteries, cell phones, we use it in airplanes. We use it to make fireworks, and most technology requires a small amount of this element, lithium.

[00:26:30] And then we can put a lot of that element with a. Cofactor called carbonate, and we have a drug, a medication called lithium carbonate that's used for bipolar illness, and we use it at doses of 900 and 1200 1800 milligrams. So we have an element that's in our rocks that gets in our water supply. Now we have a drug that's made by pharmaceutical companies.

[00:27:03] And in my world, my entire career is focused on what's in the middle, adding milligrams of lithium, two to 20 milligrams of lithium as a therapeutic agent for mental illness, and I have more research to support these low doses of lithium. Than I do probably any other micronutrient and the vast number of medications that I use as well.

[00:27:37] Christa Biegler, RD: Is there any negative to the two to 20 milligrams of lithium in all? Are you testing lithium deficiency? 

[00:27:47] James Greenblatt, MD: The average people get in their water supply might be two to four milligrams of lithium, but. Depending on where you live, the amount of water varies and just the amount of lithium in your water, whether it's tap water varies the studies we have from around the globe.

[00:28:09] 20 different communities in Texas, 10 different communities in Japan. They all have different levels of lithium and the lower lithium in the drinking water. We've demonstrated year after year study after study one meta-analysis in over 3 million patients. The lower lithium, higher rates of suicide dementia have been studied the most.

[00:28:38] Other studies looked at psychiatric admissions and violence. It's that dramatic and higher levels. If you happen to live in an area with high lithium. Or you take a drive to Lithium Springs and there is all over the country, there's one in Georgia, some in Texas, some in Canada, these lithium springs that people drink, the water, lower rates of mental health and mental illness.

[00:29:05] So it's pretty dramatic. And the research is there. 

[00:29:09] Christa Biegler, RD: Yeah. So people are gonna wanna know, how do I find out if I have lithium in my water? 

[00:29:13] In past winters, my son has gotten dry hands that can crack and bleed. I found that giving him at least 300 to 600 milligrams of high quality fish oil really resolves this in a few weeks. This year I started him on jigsaw's Alaska cud liver oil because it's the best value for high quality US sourced cud liver oil.

[00:29:31] Just one teaspoon gives him a thousand milligrams of total omega threes, which just means faster results with nature's natural dose of synergistic Vitamin A and D already found in cod liver oil to support immune health. Jigsaw sources their cod liver oil from Alaska where lying caught fish are flash frozen on the boat.

[00:29:51] This keep the fish oil very fresh so it doesn't require more processing and deodorizing like other fish oils, which can disrupt the oils and nutrients. So when you combine jigsaw's incredible cod liver oil with some of their other wonderful electrolyte mineral products, it's a winning combination to keep your skin beautifully hydrated.

[00:30:07] Year after year, you can get a discount on all of jigsaw's products, including Alaska Cod Liver oil, electrolyte, Supreme Adrenal Cocktail, and Potassium Cocktail, formerly known as pickleBall@jigsawhealth.com with the code Less Stressed 10, which you can use on each and every order. That's Code Less Stressed 10.

[00:30:27] James Greenblatt, MD: If you go on, the geological surveys, the US maps, you could look at county and you can look at your water. You can test your water. Now the problem is of being an old person, I've been looking at this for 35 years before everyone was obsessed with bottled water and we look at hair samples and when I did this 30 years ago.

[00:30:52] Up until last 10 years, I had maybe 50, 25 to 50% of undetectable lithium. In the patients I was seeing now it's much higher 'cause everyone's drinking bottled water, which is filtered and probably doesn't have the natural lithium. So it's a increasing concern. And you asked about toxicity.

[00:31:13] So if I come up with this two milligram as the average people get, and so I am quite convinced using this for 30 years and reading about it for 45 years. That two to five milligrams is completely non-toxic and safe. You don't get a blood level and there's probably some clear benefits in terms of preventative cognitive decline.

[00:31:38] And then as you get higher it's used as a therapeutic tool. 

[00:31:42] Christa Biegler, RD: Is that the only difference between prescription lithium? Is it high dose or is there. Some kind of synthetic component. 

[00:31:51] James Greenblatt, MD: No, and that's why people arguing about, the supplement lithium orate versus lithium carbonate. And it's just the car molecule.

[00:32:00] Lithium is lithium. And the most important thing people should understand is the amount of element elemental lithium is what we're comparing. So you gotta be careful with companies. It's not always listed as the amount of elemental lithium. That's what you want. And that's why to me, two milligrams is a physiological dose.

[00:32:20] Christa Biegler, RD: So prescription lithium is just a very high dose of lithium carbonate. 

[00:32:25] James Greenblatt, MD: Yep. 

[00:32:26] Christa Biegler, RD: Okay. And what happens if you get too much lithium? If something goes on and it sounds like you can test it in the blood, you mentioned it in there. 

[00:32:34] James Greenblatt, MD: Yeah. You contest prescription lithium 'cause then you get a blood level.

[00:32:38] You should not have any blood level by taking lithium orate over the counter, lithium the two milligrams. You should not have a blood level. And I've never seen side effects on two milligrams on the five milligrams I've had people say. They felt too calm and they didn't like it. And as you get higher doses, sometimes you can get headaches and irritability, but rarely again, I.

[00:33:05] Almost 40 years now using nutritional lithium, that two to five milligrams, I have not seen side effects at all. 

[00:33:12] Christa Biegler, RD: Is prescription lithium mostly used for anxiety or is there other indications? 

[00:33:16] James Greenblatt, MD: Prescription lithium is primarily used for bipolar illness. A significant major mental illness that it can be.

[00:33:23] It's incredibly helpful. I try to get people off prescription lithium quickly. My colleagues who keep them in longer. They tend to be more side effects and you can actually get kidney damage and thyroid damage if you stay on high doses for too long. 

[00:33:38] Christa Biegler, RD: That's always the good conversation to have is that most things are a little bit Goldilocks, I would say B vitamins and vitamin C.

[00:33:46] Not so much Goldilocks since they're water soluble, assuming you a monk. Functions are working properly. But some other things I always like to question. And actually that does take me back to vitamin D really quick before we go back to zinc. There are argument, back in the day, and it wasn't that long ago, they probably still do this.

[00:34:08] They were doing 50,000 IUs of vitamin D two and then they decided maybe we should give vitamin D three. And anyway, we don't have to slice and dice too much about how people dose vitamin D, but what coming from your position. There's lots of ways to think about vitamin D because it's fat soluble.

[00:34:25] You could take a loading dose, you could just take it once a week. And so I'm curious how you handle vitamin D maybe in practice, and then do you retest after a certain amount of time? 

[00:34:34] James Greenblatt, MD: Yeah, absolutely. Retesting is critical and testing to know what to do is critical. So in a mental health practice we see patients who have levels under 10 and significant in vitamin D deficiencies.

[00:34:47] So I would give 10,000 international units of D three for usually one or two months, and then retesting. The core part of my career and practice and functional. Psychiatry is this concept of biochemical individuality. Everyone's different. So I could have 10 patients with a vitamin D of 10 give everyone 10,000 international units.

[00:35:10] I. And if I retest everyone in two months, somebody's gonna go up to 60. Someone might go up to 40, someone might only budge to 30 because they might need, magnesium or other co-factors. So the testing and the retesting is really essential. 'cause you, particularly if someone's low for maintenance, it's a little easier to say Take 5,000 international units with vitamin K two.

[00:35:35] But for a deficiency state, you wanna. Give high doses and then retest to know how they utilize and absorb vitamin D. 

[00:35:46] Christa Biegler, RD: I'm glad you mentioned the K two. I was gonna ask you that. So you covered that. If you do not take vitamin D three with K two, at least your calcium can get displaced. I'm not sure all of what else can happen, but okay, cool.

[00:35:59] Let's go back and that makes perfect sense and I'll share that. I think the generally accepted reference ranges or that under 30 is low for vitamin D. So when he says 10, I would say that is atrocious. So that's how I feel about that. I would agree that I'm guessing that the symptoms are severe at that point.

[00:36:16] So I wanted to ask you, we talked about how magnesium testing isn't really accurate because of where magnesium is stored in the body. I think these are these little technical nuance conversations that must be had. 'cause when we say testing, it's not exactly straightforward for people. And so I wanna ask, do you think zinc testing is accurate?

[00:36:36] James Greenblatt, MD: I think zinc testing is helpful. Yes. Particularly working in an addiction clinic. I can't tell you how dramatically low zinc is working for 25 years in an eating disorder facility. Patients with anorexia, we had low serum zinc. Yeah we look at lots of different paths to understand if someone needs zinc.

[00:36:58] But serum levels can be helpful. Yes, there is an RBC zinc. That to me is not necessarily better because I've just been used to looking at serum and for. So many years. 

[00:37:12] Christa Biegler, RD: Yeah. Yeah. Okay. I wanna talk about, this is actually how I was introduced to you was your thought processes and concepts around zinc and disordered eating.

[00:37:21] And so it's a, my, how I would describe it is a little bit of a chicken or the egg discussion. And so will you talk about how the symptoms in disordered eating and the symptoms are zinc deficiency overlap and why? I think this is a huge part of your. Your work around anorexia includes zinc conversation.

[00:37:44] So let's dive into that just a little bit more. 

[00:37:48] James Greenblatt, MD: Yeah, let's just take one step back and share with everyone that anorexia nervosa is the highest mortality rate of any psychiatric illness, so more kids and adults die, and it also is the highest risk of suicide for any psychiatric illness.

[00:38:09] We have no treatment that is consistently used anywhere and no drugs that are approved for treatment. So I've spent my career watching too many children die and adults die from eating disorders, and there's no, a lot of great clinicians are trying. We're trying to, feed calories. We're trying to do therapy, we're trying to do this and many people recover, but many don't.

[00:38:41] And what is was mind boggling to me 25 years ago when I walked into an eating sort of facility and ending up staying for 25 years as Chief Medical Officer is these young women and young men, now were not eating. Starving and nobody was addressing the malnutrition, right? It was just calories. It was just calories to restore weight.

[00:39:07] And I, as was interested a hundred years ago in micronutrients and brain function. So started looking at it and I just discovered the zinc, connection early on in 2000. And it was just overwhelmingly clear that this micronutrient had a profound influence on almost all the symptoms that you and I would call anorexia nervosa.

[00:39:32] And there was research and. So that's, my story and we can go through some of the mechanisms, but if you, you want me to just go through zinc and eating disorders in a quick rundown for a minute? 

[00:39:47] Christa Biegler, RD: Yeah. Go. 

[00:39:47] James Greenblatt, MD: So let's just start with every aspect of digestion. Your taste buds are zinc dependent enzymes.

[00:39:56] Okay? So if you zinc deficient, your food doesn't taste well. Whether you have covid or whether you have your 80-year-old with zinc deficiency and food just tastes terrible from, and then you get more depressed so you don't taste, and that's common. If food doesn't taste good, you're not gonna want to eat.

[00:40:13] We mentioned hydrochloric acid and digestive enzymes. You need zinc to make acid and digestive enzymes. What is the most common thing we see in patients with eating disorders? I don't feel well. After I eat, I feel full. I'm bloated. I'm distended. 

[00:40:31] Christa Biegler, RD: Yeah. 

[00:40:31] James Greenblatt, MD: That is a sign of zinc deficiency. Sleep problems.

[00:40:35] You need zinc to make melatonin. You need zinc. To make serotonin anxiety, you need zinc. The list is pretty long. Attention problems, depression and we've just found zinc to be this and deficient in many of the patients that are coming in. And there was early research looking at providing zinc to patients who did better.

[00:41:00] And it's simple. It costs pennies. There's no side effects. Ask me how many treatment programs are using zinc supplements for patients with anorexia nvo? 

[00:41:14] Christa Biegler, RD: Yours? 

[00:41:16] James Greenblatt, MD: A few. Yeah. I left in the summer, but I don't know if they're still doing it, but absolutely. For 25 years. And it's not the complete answer, but it's foundational because if their appetite gets a little better, their anxiety gets better, their digestion gets better, we can work with them.

[00:41:33] Also provide other micronutrients that are deficient, but also help the cognitive distortions, the rigidity that gets in the way of recovery in a eating disorder. 

[00:41:45] Christa Biegler, RD: And everything you just said. I am gonna repeat a little bit just to, I actually have your slides in front of me from this seminar and really it's like anorexia symptoms and zinc symptoms and underneath of it are all the same symptoms.

[00:41:59] And so you said that in different words, but I'm just sharing. It's if you look up both of them, they're the same. And you mentioned this in passing and I think it was very useful you forget. When this has passed for me I did a little bit, but this was definitely in a lot of our minds around covid, right?

[00:42:14] People like didn't have. Taste for things and it's oh, was it Covid? Or actually, are you zinc deficient after covid? And and one other, another one of your slides is, again, I'm just emphasizing what you said, I just wanna like really underline it and highlight it. Is that a significant percentage?

[00:42:29] I'd love to know what you think the percentage is of your anorexia patients are zinc deficient. You see this on testing and. So this question is like, when I add the zinc, these symptoms get better. You did mention something I wanna just acknowledge and you offered earlier. You use oral magnesium glycinate, I find glycinate.

[00:42:48] To be generally most tolerated in most mineral types and so I would recommend zen glycinate also. You may have a different recommendation, but what I will say is that sometimes taking a high dose of zinc can give you a little bit of a stomach ache if you don't take it with food. So I don't know if you use a different form of zinc.

[00:43:04] James Greenblatt, MD: I'm not sure that the format matters as much. I use glycinate, picholine, but absolutely an empty stomach. Some of these patients will get nauseous and never take it again. So yeah, you always wanna take zinc after meals. 

[00:43:16] Christa Biegler, RD: And I think there was a slide where I started taking zinc and after three days I'd had an appetite, but I was scared and then I felt hungry and I stopped the zinc.

[00:43:24] So I'm sure that this is a challenge. I think this is the other side of the challenge for you, probably in practice. 

[00:43:31] James Greenblatt, MD: Yeah, that was actually a medical student who I was working with who was struggling with anorexia. And I just use that slide to remind everyone. It's not a hundred percent biological anorexia, but the biology and certainly the nutritional deficiencies are completely ignored by our current treatment model.

[00:43:50] Christa Biegler, RD: Okay. I think I can squeeze in a couple of more questions before we've gotta wrap up today. And the first one, I think is more related than the other one is going back to fatty acids and phospholipids. Are there medical conditions that mimic anorexia or eating disorders? 

[00:44:08] James Greenblatt, MD: There are many and just like in all of psychiatry, we just think of mental illness as a deficiency of one drug or another.

[00:44:16] But, for, anorexia nervosa. Probably the two that someone would need to wanna understand would be pandas. A neuro immune response to a strep infection or another infection like Lyme. So an immunological response. It looks like anorexia nervosa, they have this distaste for eating some.

[00:44:39] Kids even refuse to drink water. And the other one, it's not a cause, but it's directly related, is celiac disease. So there's a very high correlation between celiac disease and anorexia, and then patients with anorexia developing celiac disease. And to me the bridges a malnutrition, that you stop absorbing these micronutrients and then you lose your appetite, you don't digest.

[00:45:03] And then if you're around. Friends, peers, social media, and you start restricting, guess what? Those with celiac will sink deeper into that. Eating disorder. So Celiac and pandas are the two that I just urge clinicians to make sure they address and test for. 

[00:45:23] Christa Biegler, RD: Yeah. And most places aren't gonna know what pandas are.

[00:45:27] We've done multiple episodes. The audience here will know what pandas are, but, just as, that's also an area where if you ask your doctor and they look at you like you have three heads, it's okay. Maybe you find someone who knows about it. That's what you're talking about. Okay, couple more. So we've covered a lot of nutrients around brain health and you hear people talk about the importance of fatty acids and brain health, and I love phospholipids.

[00:45:50] Is this anything that you consider as well in your practice? 

[00:45:54] James Greenblatt, MD: It's essential. I think that that the research is staggering low levels of particularly omega threes associated with depression and suicide risk and anxiety and depression. The difference, the confusion part for some of my colleagues is some of the research studies by giving people.

[00:46:13] Fish oil, not everyone got better. And it just brings us back to my whole point of biochemical individuality. And we do fatty acid testing on every patient. And not every depressed patient is low in essential fatty acids. But, I just saw a woman with alcoholism and depression that, they were so low, they were almost undetectable.

[00:46:39] I've never seen anything like it, but I. Her roommate, depressed, alcoholic, completely normal fatty acids. So the important point here is the relationship is clear. The brain is 60% fat, and we need these both saturated fats, cholesterol, as well as essential fatty acids. And sometimes testing is the quickest path to know who would benefit from.

[00:47:06] Higher dose supplements. I think most of us would benefit from eating a diet higher in omega threes and small amounts of supplements. 

[00:47:15] Christa Biegler, RD: Yeah, and I can understand why omega threes are deficient because there's not an extreme amount of animal or the type of Omega-3 EPA and DHA that we use mostly salmon.

[00:47:28] Maybe algae. Otherwise you've gotta rely on your liver to convert it. And I am a person who does not convert that very well, which means I'm gonna be more predisposed to dry skin. And I'm curious how you're testing omega threes. And I wanna offer, there's an Omega-3 testing company in my state.

[00:47:42] They do a finger prick it's Omega quant and it's 50 bucks and really straightforward. And I know the people there. And you may have feelings about proper omega testing. Is there other ways that you do this? 

[00:47:55] James Greenblatt, MD: No I've said many times if I was at a big practice, again, I now just consult. Omega Quant would be a perfect path to looking at that.

[00:48:03] I think both labs look at omega threes, the routine labs don't do a great job. I. Now the Quest and LabCorp, it's hard to make sense of those tests, but a lot of the functional tests look at omega threes, it's better to do a blood cell versus plasma and omega quant is a good recommendation.

[00:48:21] Christa Biegler, RD: Yeah. So what's really important to me is that all of this work that you've been doing for. I don't, 40 years at least, gets continued. So how are we gonna continue the work of Dr. Greenblatt and keep, and make like more versions of you? You mentioned that you have some training programming, so I'm like, how are we gonna continue this work?

[00:48:42] Because it feels like you're just getting started. 

[00:48:47] James Greenblatt, MD: Yeah, really good point. And as both patients and professionals now appreciate the role of nutrition and mental health and asking for the information, so I have my last book on depression, functional medicine for depression coming out next year.

[00:49:02] We just finished that. And the psychiatry redefined.org is a training program for all clinicians. But geared towards nurse practitioners and naturopaths and doctors who can prescribe supplements and order the testing. So we're helping train doctors. We have short courses for four weeks, and then we have year long fellowships where people can really change their practice to be able to say that they're an integrative and functional mental health clinician.

[00:49:36] So that training program. We have some great faculty from around the globe, and that is growing and that'll continue for a long time. 

[00:49:45] Christa Biegler, RD: Great. We'll have to say, I hope that you're marketing to the dieticians because they can do those things as well. Otherwise, all the ones, 

[00:49:51] James Greenblatt, MD: absolutely. 

[00:49:52] Christa Biegler, RD: Otherwise, all the ones listening will be like, you forgot us.

[00:49:55] James Greenblatt, MD: No, dieticians have been part of our fellowship since we started seven years ago. And some of the most helpful comments and support has been from our fellow dieticians. 

[00:50:06] Christa Biegler, RD: Yeah, cool. As someone who has a family member with psychiatric issues and conditions, and when I heard about this, I just, I was, I felt very compelled.

[00:50:17] I'm very glad you agreed to come on the show to talk about this today, just so we can try to spread your message a bit more and even get into that nuance around how can people test and support. And I think you served us very well, so thank you very much and I hope to have you back chaga by A DHD in the future.

[00:50:34] James Greenblatt, MD: Good. Thanks for having me. Take care, Christa.